Learning Objectives. QAPI at a Glance: 8/22/16. Achieving Success with QAPI. Participants will be able to describe:

Transcription

1 Achieving Success with QAPI John Leon, RN, MPH Nursing Homes Projects Specialist, OFMQ Learning Objectives Participants will be able to describe: QAPI Process Review Data/ Identify Priorities Set Improvement Goal Root Cause Resident Event Generate Interventions Implement and Evaluate QAPI at a Glance: Use data to identify quality concerns Include staff and resident voices in goal setting and progress evaluation Develop a Performance Improvement Project- PIP Perform Root Cause Analysis- RCA Implement systemic changes to address problems at the source 1

2 Use Data to Identify Concerns MDS 3.0 Reports Facility Level Report - Identify clinical measures that are not at or above the state average Resident Level Report - Identify residents that trigger the clinical measure * Report period-default to 6 month timeframe. 4 MDS 3.0 Facility Level Report Numerator includes: All residents triggering the clinical measure Denominator includes: All residents eligible for the measure *Report includes discharged residents *Initial assessments may be excluded Review and Identify Priorities 2

3 Tracking Monthly Progress Tracking Falls with Major Injury Tracking Monthly Progress 3

4 Monitoring Success Tracking Monthly Progress Tracking Urinary Tract Infections 4

5 MDS 3.0 Resident Level Report 13 Getting to the Root Cause 14 Root Cause Analysis The highest level cause of a problem is called the root cause. Visible Problem Symptom First level Cause Higher level Cause The root cause is the evil at the bottom that sets in motion the cause-and-effect chain that creates the problem(s). Root Cause 5

6 Determine the Root Cause Benefits of The 5 Whys: Help identify the root cause of a problem Determine the relationship between different root causes of a problem One of the simplest tools; easy to complete without statistical analysis 5 Whys? PRESENTING PROBLEM: High Rate of Falls with Major Injury 18 6

7 19 Smart At-a-Glance: Sleep: Increase undisturbed, restorative sleep Mar: Improve MAR processes Transfer: Improve transfer processes Therapy: Use therapies that strengthen and positively impact balance 20 PRESENTING PROBLEM: High Rate of UTIs Accurate MDS 3.0 Coding Must meet criteria Urine testing and antibiotics Document signs and symptoms Use H2O Approach Hydration Hygiene Output 21 7

8 H2O At-A-Glance Hydration: Hygiene: Output: Increase the intake of liquids Improve perineal hygiene Ensure full emptying of bladder Quality Improvement Measures Outcome Measures: determine if the improvements are having a positive impact on our performance Process Measures: Determine if the steps in our system are performing as planned Balance Measures: Are the changes we implemented to improve one part of the system causing a new problem in other parts of the system 8

9 Balance Measure Example Residents sleep undisturbed at the night Look at changes resulting from new interventions- are they causing problems in other parts of our system? Example: Review occurrences of unchecked moisture or skin breakdown when residents are not turned every 2 hours Developing Interventions What did the Root Cause tell us? What intervention does the team want to try? Try new interventions on a small scale to learn if it works. If it does not, it wasn t a big investment and easier to change If it does, now you have staff buy-in and a success story Small scale does not equal small change 26 The PDSA Cycle for Learning and Improvement Act What changes are to be made? Next cycle? Plan Objective Prediction Plan to carry out the cycle (who, what, where, when) Study Do Complete studying Carry out the plan the data Document problems Compare data to and unexpected predictions observations Summarize what Begin to study was learned data 9

10 PDSA Plan: Develop a plan to test the idea Do: Carry out the test-record results Study: Review and study the results Act: Adopt-Adapt-Abandon Small-scale, Rapid Cycle- PDSA Purpose: Improve the quality of resident s sleep Plan: What makes good night sleep: noise, lighting, toileting Prediction- this will provide better night s sleep Do: Educate CNA with what helps resident sleep CNA assists resident to bed Resident goes to sleep Collect results Study: What were the results Act: Adopt-Adapt-Abandon Small-scale, Rapid Cycle-PDSA Purpose: Increase rounds to check on residents in rooms Plan: What is the frequency of rounds to resident rooms? (Every 30 mins.) Who is making rounds? All residents (residents in their room) Do: Identify staff to make rounds Collect results of rounds Study: What were the results of rounds every 30 minsmake a difference in falls Act: Adopt-Adapt-Abandon 10

11 Repeated Use of the Cycle A S P D Changes That Result in Improvement Hunches Theories Ideas A S P D TIPS FOR TESTING CHANGE Always plan one cycle ahead Remember - small scale test does not equal a small scale change Choose changes that do not require long process of approval Don t reinvent the wheel Evaluation Evaluation is the systematic process of reviewing data to assess progress toward achieving a goal Evaluate the degree of success a plan has had in reaching the goal(s) Identify: What worked? What didn t work? Continue with plan, make revisions, or abandon and start over? 11

12 OFMQ Resources Visit OFMQ Website for SMarTT, H2O and other resources: Thank You! Want to know more? Contact OFMQ (405)